الفهرس | Only 14 pages are availabe for public view |
Abstract Idiopathic throlllhocytopcnic purpura (1’1’1’) is a couuuon haernorrhagic syndrome characterized hy reduced number or circulating platelets. normal 10 iru.rcased number of megakaryocytes and accelerated platelet destruction . To establish the autoimmune nature of this disorder and to • find out the pathogenetic significance of serum anticardiolipin antibodies in this disease ,fifty patients suffering from ITP (twenty- five with acute ITP and twenty - five with chronic ITP) and also, age- and sex - matched twenty healthy children serving as controls had beenOsubjccted to the following: I. Detailed history taking: Onset. course. duration and history of bleeding. vaccination or fever. 2. Full medical examination: Skin lcxion», hypcrpyrexlu, orgunomeguly (lymph nodes. liver and spleen) . 3. I.ahoralory work: a) Routine investigations: Bleeding lime, haemogram with total leucocytic and differential counts. h) Haematological investigations : Platelet count, bone marrow aspirate and Coombs’ Test ( direct and j ndircct ) . c) Immunological investigations: I. Estimation of serum IgG, IgA, IgM,C3 and C4 using SUMMARY AND CONCLUSION 126 Radial immune diffusion. 2. Demonstration of anti-CMV antibodies of the IgG and IgM types using ELISA technique . ~. o 1. nt’led ion of circulaling immune complexes using HUSI\ technique • l4’ t~ ~ ! 4. Dcte<.:lion of antinuclear, anti-ds-DNA, non-organ specific and anti-thyroid antibodies by indirect immunofluor•escence technique. ,_-t , 5. Detection of serum antiplatelet antibodies by immunofluorescence technique. 6. Detection of Anticardiolipin antibodies of the IgG and IgM types using EUSA technique. Statistical analysis of the results showed; Al] cases studied had prolonged bleeding tiruc.Cljuiculty ; fever, spontaneous purpura and bleeding were statistil.:ally more prevalent in acute group as compared to both chronic and control groups. The haemoglobin level was significantly lower in both patient groups as compared to the controls . also • it was significantly lower in acute ITP patient group as compared to chronic ITP patient group.The mean total leueocytic count and absolute eosinophilic count were significantly higher in both patient groups as compared to’ the control group, also. they were significantly higher in acute rTP group as compared to chronic ITP group. o SUMMARY AND CONCLUSION 127 The mean ’platelet count was significantly lower in both p.uicru groups as compared 10 control group • also . it was significantly lower in acute TTPgroup as compared to chronic ITt> 1’.1”011 P . Serum IgG and IgM levels were significantly higher in both patient groups as compared to control group, but there was no significant change in serum IgG or IgM in acute ITP group as compared to chronic ITP group. There was insignificant change in serum IgA . C3 or C4 levels in patient groups as compared to control groups. The anti-CMV IgG results were significantly higher in both patient groups as compared to controls, also. anti-CMV IgM results were significantly higher in both patient groups as compared to control group. The results of non-organ specific autoantibodies showed insignificant difference in both patient groups us compared to each other. Anticardiolipin - IgG level was significantly higher in both patient groups as compared to control group . While . anticardiolipin IgM and circulating immune complex levels were insignificantly different in both patient groups as compared to control group. As many as ,·76% of acute ITP patients and 80% of chronic ITP patients were positive for antiplatelet antibodies. The correlations found in the results were between the platelet count and haemoglobulin concentration, absolute SUMMARY AND CONCLUSION 128 eosinophilic count ,serum IgM, serumlgA, serum CJ and serum (’4 levels. Hcncc , we could cOlll’llIdl’ lhal; ITP in Egyptian’ children may be an autoimmune disease accompanied by the presence of serum antiplatelet antihodies , <Inticardiolipin antibodies, circulating immune complex and even non-organ speci ric autoantibodies. A palpable spleen strongly negates the diagnosis of chronic ITP in children. The rising specific anti-CMV 19G titer is more useful in screening for active CMV infection than the specific anti- CMV TgM titer. |